Doctors Criticize Insurers Over Rankings

A letter, sent Monday "by several organizations including the American Medical Association, is the latest shot by doctors at such grading efforts, which have led to years of tensions between physicians and health plans. Insurers, for their part, said they are already working with doctors to ensure their ratings are accurate and transparent."

The ratings may be used to divide "doctors into tiers based on factors such as quality and cost. For example, doctors deemed to be more efficient than average, perhaps because they order fewer questionable imaging scans, might rank in a higher tier. Performance, including favorable patient outcomes, also could boost a doctor's rating. In such 'tiered,' or 'limited,' network setups, consumers may get lower out-of-pocket charges if they see a doctor in a preferred ranking. Patients would typically pay more out of pocket to see doctors who are ranked lower. At the most extreme, consumers may have to pay the full cost of seeing a physician who doesn't make the favorable list." But in their letter, doctors cite a study suggesting that the ratings are unreliable and often inaccurate (Mathews, 7/20).

The New York Times: "Citing research from Rand, the physician groups argue that the methods are too flawed to be used to direct patients to individual doctors. 'Physicians' reputations are being unfairly tarnished using unscientific methodologies and calculations,' the societies said." The research, "which looked at physician profiling by commercial insurers in Massachusetts, points out numerous shortcomings. The researchers conclude that 'the work strongly suggests that current methods of physician-cost-profiling are not ready for prime time'" (Abelson, 7/19).

The Courier-Journal: Humana, which received the letter, "said it 'remains confident in the fairness' of its measurements of physician performance. Company spokesman Jim Turner said in an e-mail that the company provides online tools for members to compare doctors and other health-care providers based on both costs and adherence to national quality standards. 'As the cost of health care increases, employers ... are demanding that incentives encourage members to seek care from high-quality providers who have demonstrated appropriate use of health-care services,' he said" (Howington, 7/19).

The Star Tribune: "Doctor ratings have come under scrutiny before. A few years ago, New York Attorney General Andrew Cuomo investigated claims that insurers were using ratings to send patients to cheaper doctors rather than better ones. That led to a 2007 agreement with national health insurers, including Minnetonka-based UnitedHealth Group. The insurers agreed to ensure doctors met quality goals before they were evaluated on cost" (Yee, 7/19).

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